Acute esophageal necrosis in the post-operative period: a narrative review of presentation, management, and outcomes.

Background: Acute esophageal necrosis (AEN) is a rare clinical condition characterized by diffuse, circumferential, black mucosal discoloration of the distal esophagus. The cause is multifactorial, frequently seen as a sequela to a large physiologic stressor such as trauma, multisystem organ failure, or sepsis. Mortality from AEN has previously been documented as high as 32%. Cases of AEN have been described in the post-operative period, however the etiology has not clearly been defined. Methods: A review of AEN was performed, predominately through case reports and small series. In combination of clinical experience and review, emphasis was placed on identification of shared risk factors, signs and symptoms and efficacious management. Key Content and Findings: Patients diagnosed with AEN frequently have a documented history of diabetes, hypertension, and chronic kidney disease. Additional risk factors include duodenal and/or gastric ulcer disease, reflux anemia and malignancy. While more common in patients with multiple comorbidities, AEN is seen otherwise healthy post-operative patients. Surgery can act as a trigger for AEN, documented after transplants, oncologic operations, and routine cholecystectomies. The most common presenting symptom was hematemesis. Management focused on early diagnosis with upper endoscopy, supportive care and reversal of underlying stressors can mitigate morbidity and mortality. Conclusions: AEN is a rare and life-threatening condition that requires early identification and intervention to prevent severe morbidity and mortality. It not only occurs in patients with multiple comorbidities but also in otherwise healthy patients in response to a large stressor, such as surgery.